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Sometimes while I watch some mindlessly good television or when I listen to some Rich Eisen podcasts, I take online surveys via those sites that pay you for taking them. Some of the surveys are rather interesting, and occasionally it’s a way to get to know what products may be in the pipeline for various brands. The other day, I took a survey that wasn’t about shopping, alcohol or cars; it was about bipolar meds—which I’m happy to answer questions about since I’m familiar with many of them. So, I began the survey only to realize several things, both about me as a psych patient and about the industry that supplies these medications.

One, it reminded me very early on in the survey that I’ve taken a lot of them (see screen shot 1-sorry about the poor quality of photo). The truth is, while I did not check every single drug they listed on this page, I probably may have taken some of those but just don’t remember them as well. Also, I’m pretty sure I’ve taken other meds not listed on this page that don’t qualify as bipolar meds per se, but are still mood altering. It was a horrifying moment to see the glowing list in front of me and having to confront my history. But the fun of this survey had only just started.

A few pages after having to confess my medication history, an interesting question was posed to me (as seen on screen shot 2: this one can be magnified): how likely am I to try the following bipolar meds? They gave me a short list of the newer p-meds out on the market, and asked me to give my inclination toward them. There was no description of the chemistry of these medications, what class of psychiatric meds they’re in, or really anything else. Just the names. Like whether I’d try Quaker Oats brand cereal versus ones by Erewhorn. While I admit that I had already taken most of them on this list, too, it made me almost cringe in having to wonder what kind of patients those of us with mental illnesses have become.

The survey eventually led to showing of several different commercials and print advertisements, and then asked me stuff like my reaction to the commercial, etc. And then it asked how likely I am now to ask for that particular drug to my doctor. It was rather insulting that these companies think I’d be persuaded to ask for a drug because their ads looked pretty. But furthermore, what is the purpose of having a psychiatrist if we, the patients, just point and ask for these medications, like we’re picking out our favorite easter candy? Well, according to this survey, our doctors really have just been reduced, to put it bluntly, to that of a drug dealer.

From taking this lovely survey, two big conclusions were drawn. As many people already know, the drug company’s job, while it is to help people through chemistry, is to be a profitable company. And like any product, they will market them to the public as allowed by law. But perhaps what’s more important to learn for people taking medications is that the responsibility is largely on us,the customer, to be alert about medications being pitched to us like a new cleaning detergent. It’s hard to be discerning when we’re so desperate to get through another day or even a minute of agony that comes with mental illness. But we really have no choice but to pay attention to what we’re ‘asking for’ or being given samples of by our doctors. And we should expect our doctor, the person we paid for in order to get their professional advice, to steer us to make informed decisions when taking new meds.

I wish I had taken a few more screen shots of this survey since it was quite fascinating. But more than that, it made me worried about the direction that the treatment of mental illness is taking in regard to the approach that tries to make us try medications like we’re choosing our next favorite cereal.

A little while ago when I was making an effort to be less of a hoarder, I came across a piece of paper I hadn’t seen in a long time. It was my psych hospital discharge sheet from September 2004, the stay that came about because of a wholehearted attempt at suicide. What was most interesting about looking at this sheet was the list of medications that I was told to take……something like eight different things.

I’m sure the doctors that treated me there meant well (and even gave me a new diagnosis), but now that I look back on this and the rest of my journey in ‘treating’ the illness, it seems to like they are just throwing any potential drug that could work for the problem and seeing if it sticks. Well, some of it stuck alright. The depakote they started me on then made me gain at least 30 lbs. within months. Some of the drugs I took to replace the depakote then led to a problem that made the neurologist think I had a serious spinal cord disorder, followed by seeking help for those symptoms at the Mayo Clinic. The verdict from the doctor at the Mayo Clinic? It’s just a side effect.

The thing about ‘just a side effect’ is that it puts limits on your life that’s even more crushing than the original illness. And what many people end up doing is seeing that side effect as part of the illness, even if it’s not. We start to reason with something that should not be tolerated. Replacing one symptom with a different side effect is not effective treatment.

And with direct-to-consumer marketing of these psych drugs, they’ve planted into our heads that all will be fine if we just find the pill, or a perfect combination of all sorts of pills. You know what? The commercials for these drugs are done with cartoon women and their talking balloons because this world where any mental issue can be fixed with a single pill doesn’t exist!! My anger isn’t out of any belief of mine; it’s born out of experience. I have taken at least 30-40 different psych meds over the last ten years, and I took them willingly. What I’ve come to realize over the last year or so is that some of your problems may be the illness, but really, if you’re not willing to fix other issues in your life, then your illness will never get better. The current circumstances of your life situation will not change no matter how many drugs you take.

I used to hang on to old medication that I wasn’t taking anymore, admittedly so that when that ‘calling’ comes for me to kill myself, I will have adequate supplies to do so. But things have changed, and I decided that the best thing to do is to use those pills as decoration (see photo).

I threw the discharge paper away with all the other things I don’t need to hold on to anymore. Am I off all psych meds? No, and that’s not necessarily my goal. But before people just start accepting any and all pharmacological treatment, just make sure to also take a hard look at what else is going on in your life that’s making you unhappy.

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It’s early afternoon on a Friday, and I’m sitting inside a Starbucks, facing a giant window that allows me to watch all the people coming and going from this retail strip. The sky is gray today, and it’s as if you can see all the individual droplets of rain that’s hitting the pavement since they are all close to being snowflakes, but not quite. There is no sign of the sun or the blue sky coming anytime soon. There are no leaves on the trees, so the branches have that look of bleakness that they sometimes give off when they look more like old, frail fingers instead of supporters of green leaves.

In spite of what I can see out this window, I know spring is coming.

Money has been tight in our household. My fiance is in graduate school full-time, and I haven’t had a real job in months. This current situation, looking at it on its own, looks bleak. But the thing is, the reason why I came to Starbucks today wasn’t to pass some time. It’s to work on an article I have to write for a freelance gig that I have. I know I’m being grossly underpaid, but I’m getting paid, to write. The topic I’m having to write about today is advice about becoming successful as an entrepreneur. I’m using an analogy about how you need to start with a narrow focus or a product for the business, because businesses are like planting trees. Trees all need that single root that anchors them so that they can grow for years to come and weather the storms and all the bad stuff that can happen to trees.

I have to look at these little gigs as all part of an actual desire to be writing and editing professionally. And I can’t get there without doing more writing and editing for anyone that needs it, at almost any price. Building experience in retail (the old job) doesn’t count for anything if my goal is to not be in retail. So, as much as I am worried about the finances (not to mention planning some sort of a nuptial plan, since I’m engaged and all), I recognize that I am doing what needs to be done. I really have no choice but to get it done, but I also know that I was the one that made the choice to do so.

…………though I must say, I felt some relief when my fiance got a call today from a business about doing bookkeeping for them (he’s studying accounting).

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it’s been a while since I’ve been here. It was more of a forced abandonment , really. Perhaps I’ll explain about it sometime later. The main issue had to do with a sister who found out about this blog, and then threatened to tell about the blog to other members of the family if I didn’t give in to certain demands. I was crushed. Any remaining flame of my desire to write that I had kept lit through the use of this outlet was blown out. I became afraid to say anything. The sadness was nearly unbearable but the voice of mine couldn’t be used to alleviate any of it, because someone decided to take it all away. My mind and body found themselves in a prison of its own making.

Now it’s been well over a year since my self-imposed silence, not only on writing, but on many aspects of my life. Especially communicating with others. One person that I kept in touch with throughout this time is my boyfriend—-who is now my fiance. And over the last few days, we have been spending the days at our place with his almost-tween daughter and a teenage half-brother of hers, whom he takes in as his own. We’ve been doing what families do around this time of year, like put up lights on the porch, watch movies and eat together. I’ve watched my fiance teach his little girl how to use a knife properly in chopping vegetables and to knead dough. And I’ve spent some time talking to the teenage boy about our fantasy football teams. This morning we opened presents, and in the afternoon, we sat down for a full Christmas dinner, with all the trimmings around the ham, and the cat sitting on the table, waiting for his share of that smoked meat.

I write this tidbit as I hear the sound of some x-box game going on as the teenager shows the dad how to play the game. And I hear the little girl playing with her littlest pet shop toys, as she makes up elaborate backstories for each one of the little plastic animals (the cat is in that same room, asleep, and full of ham in the tummy). It’s truly odd that this person who thought she could never come to love other people has somehow come to love another person…..and then some more. The other day at the mall, I happened to be talking to the salesperson who helped us pick out my engagement ring, and I told her that I am just so happy to have more people to love this holiday. And the thing is, I really am so absolutely, wonderfully grateful to be in this moment. It’s not one that I ever pictured for myself, but it is one that I won’t trade for anything.

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My friend Alexandra recently recommended me to be a member on the Young Professionals Board of the Park Center, a local agency that provides opportunities and promotes recovery of persons with mental illness through holistic services that focus on their needs, choices and strengths (See their PSA above). I haven’t been officially ‘inducted’ into the group yet, but with a meeting coming up with their development director in the next week, it’s almost certain that I will soon be on the board of the Park Center in the fall. It’s an incredibly exciting opportunity for me, and I hope that I can gain further insight into the mental health community through being involved with this organization.

I think this commitment will affect this journal/blog in some way, because I’m definitely looking forward to talking about all that the Park Center does, because their gamut of programs, from homeless outreach to pre-employment vocational services, are really amazing. Because I do have this blogosphere platform, I believe I have an obligation to talk more about mental illness beyond my own experiences. While I don’t plan on changing the tone of this journal, I’m sure that, as I become more aware about the projects that they have, I’ll certainly be more inclined to write about them.

My soon-to-be relationship with Park Center will open an amazing new chapter to becoming more than just a blogger about the mental health community, and I’m really looking forward to it!

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I’ve been gaining pound after pound over this entire year, and it’s been really hard to figure out why. It’s true that I’ve gone out to eat more often during the week now that I have the boyfriend to have fun doing things like that. But that doesn’t really explain for the extra twenty or so pounds I’ve put on in the last several months (about forty pounds total over the last two years). I work out about three times a week and even tried the 1,500 calories-a-day diet for a couple weeks, but the weight didn’t budge a bit. Finally, when I met my psychiatrist today, I complained about my weight. As I told her how much I weighed, she made a sound indicative of shock, and then immediately said, “It’s the Abilify.”

She was hesitant to take me off of Abilify since the combination that I’m currently on has been fairly well tolerated by me. And with school starting in a few short weeks, she wasn’t sure this was the best time to test out a new mood stabilizer. So, she gave me a choice as to whether I wanted to try something else later or now. I picked now.

Because I’ve been on quite a number of different of meds, the options have dwindled quite a bit. So she thought it’s time to try something new, as in they haven’t even made some animated commercial for it for television yet. It’s called Latuda, and it’s currently been FDA-approved for treatment of schizophrenia. Apparently, it’s supposed to be weight-neutral, but can cause tremors, which I’m not a fan of because of previous experiences with similar issues.

I really hope I lose some weight, but I’m really hoping that Latuda does make a good fit for me.

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I posted the animated Abilify commercial on the site in March, and was fascinated with the depression ‘blob’ that follows the depressed woman around. I came across this what I’m guessing is a pretty new commercial for Seroquel XR the other day and noticed that this one features a cloud that follows the depressed people wherever they go.

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I’ve been having a really hard time getting up in the morning. I could stagger from the bed to the couch, but I can easily fall right back asleep for hours. It’s not like I’ve been going to sleep that late. It’s gotten to a point where I can sleep even after 11 a.m., which kills trying to get anything accomplished in the morning. Then I’m having a somewhat similar problem at night where I start falling asleep, sometime after dinnertime. What am I doing wrong?

Apparently, this ‘condition’ could be called hypersomnia (excessive sleepiness, tiredness), and I came across a new study that reported that hypersomnia among bipolar disorder (BD) patients who are in an inter-episode period may predict future depressive symptoms. According to the article in the Journal of Affective Disorders, Allison Harvey (University of California, Berkeley) and team explain that BD patients “in the inter-episode period spend roughly 50% of their time unwell, and these symptoms predict relapse into mania or depression. Hence, there is a critical need to identify aspects of the illness that contribute to inter-episode dysfunction and to relapse.” (Below this post is a shortened version of the article)

So, what am I to do about this? If I fix my sleep issues, would I be able to avoid a possibly incoming depressive episode? This particular study doesn’t answer that question, but I’m hoping that this is the case. If anything, I can go back to getting to sleep around the same time every night and try my hardest to get up at the same time each morning. If that means curing my hypersomniac tendencies as well as ward off future depression, I’m more than willing to follow that rule.

Background
Hypersomnia in inter-episode bipolar disorder has been minimally researched. The current study sought to document the prevalence of hypersomnia in a sample of inter-episode patients with bipolar disorder and to examine the relationship between hypersomnia and future bipolar depressive symptoms.

Methods
A total of 56 individuals with bipolar disorder (51 type I + 5 type II) who were currently inter-episode, along with 55 non-psychiatric controls, completed a baseline assessment, including semi-structured interviews for psychiatric diagnoses, sleep disorders, and a battery of indices that included assessment of hypersomnia. Approximately 6 months later, participants were recontacted by telephone and mood was re-evaluated.

Results
Three of six indices suggested that approximately 25% of participants with bipolar disorder endorsed symptoms of hypersomnia in the inter-episode period. Within the bipolar group, hypersomnia in the inter-episode period was associated with future depressive symptoms. This finding was independent of baseline depressive symptoms and medication use.

Limitations
Small sample size and concurrent psychopharmacology in the bipolar sample.

Discussion
Though no gold standard measure for hypersomnia currently exists, this research takes a step towards identifying a clinically and empirically useful hypersomnia assessment. This study demonstrates that hypersomnia in the inter-episode period of bipolar disorder relates to future depressive symptoms, and adds to the growing body of evidence on the importance of inter-episode symptoms predicting bipolar relapse.

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The summer’s not yet over, but I’m already looking back at it. I think about the hypomanic episode I had and bouts of depression following it. In fact, those moments of depression never seem to be that far away. Everyday I take medication in effort to keep all those things at bay, and see a therapist weekly. And, oh yes, the ‘little spark,’ too. Electroconvulsive therapy is still on the roster.

I’m not sure this is what I expected. It’s been over two years since my first series of ECT treatments, and I’m still just maintaining, not necessarily thriving. People talk about ECT being a life saver and the ‘magic bullet,’ but as time goes by, I’m not sure if that’s how I would view the experience anymore. Yes, I’m still alive, and that’s (I guess) a good thing, but—-Where would I be had I not had those shock treatments? Would I be dead, or in a much worse shape than I am in now? Or would I have eventually found my way to this emotional point that I am currently at? I’m still taking mostly the same cocktail of meds. What criteria determines if, and to what degree, I’m doing better?

Perhaps I’m making some logical error in contemplating this whole thing. After all, constant suicidal thoughts did pretty much go away after all the ‘little sparks.’ And wasn’t that the point? Didn’t the treatments accomplish their goal? I may be asking a question that can’t really be answered. I could just as easily ask “what if I had never started taking meds,” but I don’t seem to be doing that. Instead, I keep coming back to whether ECT was the right treatment to have—and still be having.

I seem to give some people the perception that I am obviously an avid endorser of ECT because I have a journal/blog that talks about the subject. But I don’t think that’s what my purpose is in writing on this topic. While I admit that I’m not anti-ECT, I am constantly conflicted about getting this treatment. But maybe I should also be just as conflicted by the medication.

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One of the things that binds me and the boyfriend together is our extensive experience with depression. Because of our shared illness, we’ve definitely accumulated some unresolved issues that influence how we think, and ultimately influence how we interact with each other. Nothing is really going wrong in the relationship, but I really felt like our wounds from the past would heal—and thus lead to a better relationship—if we discussed our problems and concerns more openly.

That’s why I asked him to come with me to my therapy sessions. And he agreed.

My therapist also specializes in couples therapy, so we decided to show up together every other session (I still need some time to myself on the other weeks). I don’t really know what I expected, but so far, it’s been a learning experience to have another person incorporated into the session. Yes, I do think that it’s already made our relationship stronger by airing out our laundry in this format, but I also think that I’ve learned something about making a good relationship.

First, you really have to listen to what the other person is saying. I think one aspect of couples therapy that is totally different from individual therapy is that, well, obviously there are two of us (plus the therapist) in the room, and it’s not just you now; you must listen to what your partner is saying. Sometimes it’s easy to tune out the other in an ordinary setting, but therapy teaches you to be attentive to your mate.

Second, you must be ready to respond to what your partner has just said. Listening isn’t enough. I’ve learned that when the boyfriend has brought up a certain issue to the table, it’s my responsibility to react in some way. In order to solve a problem, I can’t just be quiet. It’s no longer my problem or his problem. It’s our problem, and it takes both of us to solve it. And while what the therapist has to say is important, our own feedback is crucial.

Third, you have to learn to communicate clearly. At home if I’m annoyed by something, I could just give a vague reaction. In a therapy setting, I must be able to express what it is that I’m annoyed about. That means digging down and organizing my thoughts about a certain issue before opening my mouth. Therapy teaches me to be precise about how I feel and communicate those feelings to my partner.

Finally (for now), you have to keep talking. I tend to just stop talking if there’s another person in the room that can do the talking. This does not do the relationship any favors. I realized that in bettering communication, I must do the communicating. The fact is that if I don’t say what’s on my mind, I can’t expect the other person to figure it out.

So far, I believe this experience has been a valuable part of building this partnership, and I hope I can keep learning more about creating a better relationship. But what’s a huge bonus from going to therapy together? There’s a Mexican popsicle shop (Las Paletas) on the same street. Nothing like a post-therapy ice-pop to decompress from an hour-long session.

My friend is an undergraduate student at an university in southeastern United States, and is conducting research into the barriers which people perceive when they try to access mental health services, and whether or not a person’s race influences their perception of those barriers. He is conducting a series of online focus groups. If you are interested, by clicking on the link below (or here: bit.ly/kx3AiE), you will be taken to a prescreening survey where you will answer some basic demographic questions and enter contact information; the survey take less than 5 minutes. He will then email or text you the passcode information for the chat room While the chat sessions will be recorded, no identifying information will be associated with the transcript, and the only people who have access to your name will be him and his faculty advisor.

Because this is a study about racial barriers, you must be willing to identify your ethnicity, so that data can be generated from the sessions. You do not need to have received mental health treatment to join the discussion. If you are not available for any of the chat sessions, please contact him at mattb291@gmail.com and he will attempt to set a time for an interview. Thank you in advance for participating in the discussion about this important topic.

And if possible, please pass this message on to anyone that might be interested!

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Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, according to new research. In an article that is likely to ignite new controversy in the hotly debated field of depression and medication, an evolutionary psychologist concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression. (read the story in ScienceDaily)

Below is the abstract for the research which was published in Frontiers in Psychology:

Some evolutionary researchers have argued that current diagnostic criteria for major depressive disorder (MDD) may not accurately distinguish true instances of disorder from a normal, adaptive stress response. According to disorder advocates, neurochemicals like the monoamine neurotransmitters (serotonin, norepinephrine, and dopamine) are dysregulated in major depression. Monoamines are normally under homeostatic control, so the monoamine disorder hypothesis implies a breakdown in homeostatic mechanisms. In contrast, adaptationist hypotheses propose that homeostatic mechanisms are properly functioning in most patients meeting current criteria for MDD. If the homeostatic mechanisms regulating monoamines are functioning properly in these patients, then oppositional tolerance should develop with prolonged antidepressant medication (ADM) therapy. Oppositional tolerance refers to the forces that develop when a homeostatic mechanism has been subject to prolonged pharmacological perturbation that attempt to bring the system back to equilibrium. When pharmacological intervention is discontinued, the oppositional forces cause monoamine levels to overshoot their equilibrium levels. Since depressive symptoms are under monoaminergic control, this overshoot should cause a resurgence of depressive symptoms that is proportional to the perturbational effect of the ADM. We test this prediction by conducting a meta-analysis of ADM discontinuation studies. We find that the risk of relapse after ADM discontinuation is positively associated with the degree to which ADMs enhance serotonin and norepinephrine in prefrontal cortex, after controlling for covariates. The results are consistent with oppositional tolerance, and provide no evidence of malfunction in the monoaminergic regulatory mechanisms in patients meeting current diagnostic criteria for MDD. We discuss the evolutionary and clinical implications of our findings.

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There are days when I am so annoyed with myself that I don’t really know what to do. That day is today. Since the time I woke up, I’ve felt all angry inside, and don’t know how to release all of that tension. Instead of listening to my professor in class today, I drew a picture of a person’s head that’s confused. Also, It inevitably got inflicted onto my boyfriend, who takes it as a sign that I am annoyed with him. But the thing is, it’s not really about him that’s getting to me. I’m just annoyed at myself, for being fat, for not being able to have a clean house, for not accomplishing anything of value, etc. We went and had a martini at a restaurant early in the evening, and he told me that despite all that I’m feeling, I am valuable. I really did appreciate him for saying that, but I still feel like I’m ruined.

I know I’m wasting time feeling sorry for myself (which I’m not sure this is exactly what I’m doing, but I’m sure not helping myself any by feeling this way), and it probably might help to just open up and tell someone how I feel. But if I do pour out all this crap, it’s like I’m exposing someone to a virus, contaminating everything in sight. And the last thing I want to do is hurt other people.

I saw the quote above on a book at West Elm the other day. As much as I thought I agreed with the quote, now I’m not so sure. Right now, I’d really rather have a perfectly kept house so that I didn’t have to show anyone how messed up I am.

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When I come home, I am greeted each and every time by my cat, Simon (see above). Lately, he’s been sitting on my sweater that’s on the table, but other times, he trots on by to say hello. It’ll be seven years in September since I adopted him as a little kitten from the humane association. In the time that I’ve known him, I haven’t had a suicide attempt. Is it coincidence or has my cat affected my mental health? Journal of Personality and Social Psychology (an online publication by the American Psychological Association) just published a paper titled “Friends with Benefits: On the Positive Consequences of Pet Ownership” which contends that pets indeed are good for our mental health. “Specifically,” said the lead researcher Allen R. McConnell, “pet owners had greater self-esteem, were more physically fit, tended to be less lonely, were more conscientious, were more extraverted, tended to be less fearful and tended to be less preoccupied than non-owners.”

Below is their abstract:

Social support is critical for psychological and physical well-being, reflecting the centrality of belongingness in our lives. Human interactions often provide people with considerable social support, but can pets also fulfill one’s social needs? Although there is correlational evidence that pets may help individuals facing significant life stressors, little is known about the well-being benefits of pets for everyday people. Study 1 found in a community sample that pet owners fared better on several well-being (e.g., greater self-esteem, more exercise) and individual-difference (e.g., greater conscientiousness, less fearful attachment) measures. Study 2 assessed a different community sample and found that owners enjoyed better well-being when their pets fulfilled social needs better, and the support that pets provided complemented rather than competed with human sources. Finally, Study 3 brought pet owners into the laboratory and experimentally demonstrated the ability of pets to stave off negativity caused by social rejection. In summary, pets can serve as important sources of social support, providing many positive psychological and physical benefits for their owners.

This research is a pretty big deal considering that most previous research into the benefits of pets has looked only at the relationship between two variables, but didn’t show any real correlations. In addition to the social support provided by the pets, the researchers also found that pet owners were just as close to key people in their lives as to their animals, indicating no evidence that relationships with pets came at the expense of relationships with other people, or that people relied more on pets when their human social support was poorer.

It is a fascinating study, especially since it’s a very quantitative one involving experiments rather than compiling a bunch of anecdotal, qualitative evidence from pet owners.